Jonathan J. Stone, Adam J. Doyle, Anthony Carnicelli, Sean J. Hislop, Michael Singh, Jason Kim, Jennifer L. Ellis, Nicholas J. Gargiulo, David L. Gillespie, Ankur Chandra
University of Rochester, Rochester, NY.
OBJECTIVES: The use of cross-sectional area on CT angiography (CTA) for the calculation of carotid artery stenosis has been suggested but not yet validated in a large population. The objective of this study was to determine whether CTA-derived cross-sectional area was able predict carotid stenosis with a level of confidence similar to traditional NASCET measurements.
METHODS: A retrospective review was performed for all patients who underwent both carotid duplex ultrasound and CTA between 2000 and 2009. Vessel diameters and cross-sectional area measurements were made and ultrasound velocities were recorded. Percent stenosis was calculated using the NASCET technique with both diameter and cross-sectional area. Receiver operating characteristic curves were created for both stenosis groups using Strandness ultrasound criteria as a surrogate for true stenosis.
RESULTS: A total of 610 vessels were analyzed and used to create ROC curves. In the diameter-based stenosis group, area under the curve was 0.961 for 80-99% and 0.795 for 50-80% stenosis. For cross-sectional area derived percent stenosis, the area under the curve was 0.946 for 80-99% and 0.803 for 50-80% stenosis. Furthermore, the correlation coefficient between diameter and cross-sectional area derived stenosis was 0.987.
CONCLUSIONS: Using cross-sectional area to calculate percent stenosis on CTA yields similar ROC curves as traditional NASCET methods. This confirms that the two-dimensional NASCET technique can accurately classify stenosis even though vessels are often irregularly shaped. Clinical studies are needed to determine if there is any role for cross-sectional area in the prediction of stroke.
AUTHOR DISCLOSURES: A. Carnicelli, Nothing to disclose; A. Chandra, Nothing to disclose; A. J. Doyle, Nothing to disclose; J. L. Ellis, Nothing to disclose; N. J. Gargiulo, Nothing to disclose; D. L. Gillespie, Nothing to disclose; S. J. Hislop, Nothing to disclose; J. Kim, Nothing to disclose; M. Singh, Nothing to disclose; J. J. Stone, Nothing to disclose.
Posted April 2012